The extracorporeal membrane oxygenation (ECMO) procedure aids in the provision of prolonged cardiopulmonary support, whereas the Impella device (Abiomed, Danvers, MA) is a ventricular assist device that maintains circulation by pumping blood into the aorta from the left ventricle. Blood is circulated in parallel with the heart by Impella. It draws blood straight into the aorta from the left ventricle, hence preserving the physiological flow. ECMO bypasses the left atrium and the left ventricle, and the end consequence is a non-physiological flow. In this article, we conducted a detailed analysis of various publications in the literature and examined various modalities pertaining to the use of ECMO and Impella for cardiogenic shocks, such as efficacy, clinical outcomes, cost-effectiveness, device-related complications, and limitations. The Impella completely unloads the left ventricle, thereby significantly reducing the effort of the heart. Comparatively, ECMO only stabilizes a patient with cardiogenic shock for a short stretch of time and does not lessen the efforts of the left ventricle ("unload" it). In the acute setting, both devices reduced left ventricular end-diastolic pressure and provided adequate hemodynamic support. By comparing patients on Impella to those receiving ECMO, it was found that patients on Impella were associated with better clinical results, quicker recovery, limited complications, and reduced healthcare costs; however, there is a lack of conclusive studies performed demonstrating the reduction in long-term mortality rates. Considering the effectiveness of given modalities and taking into account the various studies described in the literature, Impella has reported better clinical outcomes although more clinical trials are needed for establishing the effectiveness of these interventional approaches in revascularization in cardiogenic shock.

Scleredema adultorum of Buschke is a rare condition that presents as a scleroderma mimic and portends a diagnostic challenge to the clinician. It may be associated with monoclonal gammopathy, upper respiratory tract infection, or type II diabetes mellitus. In addition, it is associated with dermal collagen and aminoglycan deposits that cause the skin to thicken and stiffen. Typically, thickening and tightening begin in the neck and progress to the upper body, including the face, scalp, shoulders, and trunk, but sparing the palms and soles. Patients with minor skin involvement may not suffer any symptoms, whereas those with significant skin disease may develop stiffness and functional impairment. There are rare reports linking scleredema adultorum of Buschke with several infections such as human immunodeficiency virus infection, acquired immunodeficiency syndrome-related lipodystrophy syndrome, and streptococcal infection of the upper respiratory tract. Here, we present a case of scleredema adultorum of Buschke associated with hepatitis B infection.

Polycythaemia is dened as an increase in the haemoglobin above normal. This increase may be real or only apparent because of a decrease in plasma volume (spurious or relative polycythaemia). Often patients with polycythaemia are detected through an incidental nding of elevated haemoglobin or haematocrit level. Patients with polycythaemia may be asymptomatic or experience symptoms related to the increased red cell mass or the underlying disease process that leads to the increased red cell mass. The dominant symptoms from an increased red cell mass are related to hyper viscosity and thrombosis (both venous and arterial), because the blood viscosity increases logarithmically at haematocrits >55%. We are presenting a case of a patient aged 30 years presenting with fatigue, headaches, dizziness, recurrent multiple joint pain.

Securing a patent airway in patients undergoing general anesthesia is routinely done using gold standard methods of direct laryngoscopy with a Macintosh or Miller laryngoscope blade in children. However, this technique has several limitations. Video laryngoscopes provide the user with a better view of the larynx. We undertook this prospective, randomized, controlled trial to determine the intubation time of Airtraq compared with Macintosh laryngoscope in pediatric patients, number of intubation attempts, quality of visualization, optimization maneuvers, easiness of intubation, and cardiovascular changes during intubation. A total of 80 pediatric patients of either sex, between ages three to twelve years, belonging to American Society of Anesthesiologists (ASA) status I and II, who were divided equally into two groups using the sealed envelope technique. Patients were randomly assigned to be intubated with either Airtraq (Group A) or Macintosh laryngoscope (Group M).  The difference between the time required for intubation within the two groups was significant (p < 0.05), optimization maneuvers were more required for Group M than Group A (p < 0.01). Quality of visualization was better in Group A compared with patients in Group M (p < 0.05).